Intravenous infusion is the therapeutic introduction of a fluid, such as a saline solution, into a vein for the treatment of a wide variety of different health problems. On the human body, there are a number of possible venipuncture sites. There are peripheral venipuncture sites on the scalp, upper extremity and lower extremity and there are central venipuncture sites which access the vena cava.
The major superficial veins of the scalp are the frontal, superficial temporal, posterior auricular, supraorbital, occipital and posterior facial. In the upper extremity, venipuncture sites include the cephalic, median basilic and median antecubital veins in the forearm. In the dorsum of the hand, the commonly used veins include tributaries of the cephalic and basilic veins, as well as the dorsal venous arch. The saphenous veins, the median marginal veins and the veins of the dorsal arch of the extremities are also used.
Central venipuncture sites include the external jugular, the internal jugular or the subclavian vein. The inferior vena cava is entered through the femoral vein.
The selection of a site depends on a host of considerations including the age of the patient, condition of the patient, what kind of fluid is to be infused, rate at which the fluid is to be infused and so forth. In general, if the patient is an adult, the best venipuncture sites, in order of preference, are the lower arm and hand, the upper arm, and the antecubital fossa. If the patient is an infant, a scalp vein may be used because it is accessible and easy to protect.
Needles and catheters of various sorts are used for intravenous infusions. In the past the same needle used to puncture the vein was also used for infusing the fluid. Present practice, however, is to infuse the fluid through a catheter that is planted with a needle which is then withdrawn. Currently there are two major types of catheters--namely, over-the-needle catheters and through-the-needle catheters. A third type, butterfly needles, formerly used in treating children, have been superseded by over-the-needle catheters.
Old fashioned needles and modern catheters terminate in a hub for connection to a fluid supply line by means of a separable tapered part. The friction joint between the hub and the supply line sometimes becomes detached. When this happens, fluid is lost and the patient may be seriously affected beyond the value of the fluid lost. Needles and catheters are also subject to inadvertent displacement whereby the needle or catheter is withdrawn from the vein or perforates the vein's opposite wall causing the infusion fluid to infiltrate the surrounding tissue and it to swell. This thwarts infusion therapy and causes other problems. Displacement of the needle or catheter is particularly likely when the venipuncture infusion site is adjacent a joint.
The simplest way to stabilize the joint between the hub and the supply line and to prevent the needle and catheter from being displaced is with adhesive tape. The supply line is taped to the patient with a small loop giving the tubing more play and making the needle or catheter less likely to become dislodged if the tubing is accidentally pulled. If the venipuncture site is adjacent a joint, the joint is often immobilized.
In addition to tape, various devices have been proposed for guarding the needle or catheter at the infusion site and for protecting the joint between the needle or catheter and the supply line. Many of these devices are specially designed for use at a particular infusion site and are big, expensive and mechanically complicated. For example, there are devices with domes over the infusion site and with means for immobilizing the elbow joint for intravenous infusion adjacent the joint of an adult. There are other special purpose devices for protecting the infusion site on a child's scalp and so forth.
If the site is taped but otherwise unguarded, the catheter may still be accidentally dislodged or, in the case of adult patients with impaired senses and pediatric patients, pulled out by the patient or one of his visitors. A taped but otherwise uncovered infusion site may frighten pediatric patients and be a stressor even to adults, particularly if they are very old or sick.
There are several general purpose guards on the market for covering the infusion site (i.e., not designed to fit a particular venipuncture site). One of them is sold by Consolidated Medical Equipment, Inc. under the name "Veni-Gard" and another is sold by Mac Lee Medical Products under the name "IV Induction Cover". The Veni-Gard device for securing I.V. needles is a clear piece of plastic in a frame treated with adhesive. The frame is positioned over the infusion site and stuck to the patient with the adhesive. While the clear piece of plastic covers the site, it does not cushion the needle or catheter from above. The IV Induction Cover sold by Mac Lee is a generally clear plastic cup with a hole in its sidewall and a flanged lip treated with adhesive. The supply line is passed through the hole in the cup and the cup is fitted over the infusion site and stuck to the patient with the adhesive. While the IV Induction Cover is somewhat flexible, the flange keeps it from being universally useful. When the cup is removed, the supply line tends to jiggle the needle or catheter.
Because of the problems with commercially available guards, many nurses jury-rig I.V. covers from a urine specimen cup or the like. The cup is cut in half vertically (or horizontally depending on the application) and the cut edges wrapped with adhesive tape. It takes a nurse several minutes to make a taped half-cup and it is a very poor use of nursing time, particularly when the staff has a heavy patient load. In addition, the cover is not universally useful at all venipuncture sites or on all patients (e. g., pediatric patients) because it is stiff and will not conform to the site.
In view of the above, there is a continuing need for a general purpose guard for an infusion site which can be used at peripheral and central venipuncture infusion sites and on pediatric and adult patients.